Artery Plaque Boosts Hispanics' Odds for Stroke

(HealthDay News) -- Hispanic Americans with even a small amount of plaque build-up in their carotid artery -- the vessel that supplies blood to the brain -- are up to four times more likely to suffer or die from a stroke compared to those with clear arteries, a new study finds.

"These results are important for developing stroke and vascular prevention programs for all, but also for certain ethnic groups such as Hispanics, who represent the fastest growing minority population in the U.S.," study author Dr. Tatjana Rundek, of the Miller School of Medicine at the University of Miami in Florida, said in a prepared statement.

The research included almost 2,200 men and women who took part in the multi-ethnic Northern Manhattan Study, in New York City.

Using ultrasound, the researchers found that 58 percent of the participants had carotid artery plaque, and that 25 percent of them had maximum carotid plaque thickness (more than 1.9 millimeters of plaque).

After an average follow-up of seven years, 121 of the study participants had suffered or died from ischemic stroke (blockage of blood flow to the brain), 118 had suffered or died from heart attack, and 166 had died of other vascular causes.

The researchers found that Hispanics with the thickest amounts of carotid artery plaque were three to four times more likely to suffer a stroke, heart attack, or some other type of vascular event than Hispanics with no carotid artery plaque.

The study appears in the March 19 issue of the journal Neurology.

"More research is needed though to determine why Hispanics with even small amounts of carotid plaque are particularly susceptible to vascular events," Rundek said.

This study also showed that ultrasound measurement of carotid plaque offers doctors a simple method of determining a patient's stroke risk and guiding stroke-prevention therapies.

"It is a non-invasive marker that can help doctors identify the beginning stages of atherosclerosis, or hardening of the arteries, that is also associated with increased risk of stroke," Rundek said.

More information
The U.S. National Heart, Lung, and Blood Institute has more about atherosclerosis.

Geckos' feet inspire new high-tech bandage

CAMBRIDGE, Massachusetts (CNN) -- Lizards with hairy feet are the inspiration for a new medical product that could help surgical patients heal better and might even replace sutures some day.

Scientists at Massachusetts Institute of Technology say they have created a new kind of surgical adhesive, formed in a shape that, at the microscopic level, mimics the feet of geckos.

Gecko feet are a worthy model to imitate, because the lizards are masters of adhesion -- the force that makes two substances stick together on contact.

"The gecko has the amazing ability to walk up walls and hang from a single foot," said Jeff Karp, a researcher at Harvard-MIT Division of Health Sciences and Technology. "They have hundreds of thousands of hairs on the surface of their feet and then on each one of those hairs they have these tiny nanopillars." Watch geckos' feet in action »

The nanopillars, one hundredth as thick as a human hair, provide an enormous amount of contact surface, and that leads to remarkably strong adhesion, Karp told CNN.

By copying that structure as a shape for their glue-coated polymer, the MIT scientists think they can build a material that will cling tightly to tissue.

It will be especially useful for applications inside the body, said Dr. Bob Langer, another researcher on the project, calling it "an internal Band-Aid."

"For example, it might be used in holding tissues together that normally couldn't be held together ... say, in hernia repair," Langer said. It could also be used to prevent leaks in gastric bypass operations, Karp said.

The new product will be stretchy and will stay stuck even in wet places inside the body, according to the MIT researchers. It can be adapted to different applications and could incorporate antibiotics or other drugs, they said -- like a transdermal patch worn on the inside. It will dissolve inside the body over time, and the scientists can tweak the rate at which that happens, they said.

Karp said the new bandage material could be particularly useful in laparascopic procedures, where a surgeon operates through a very small incision.

"Our surgical collaborators think that this may even replace sutures one day," he said. "Sutures are very difficult to place within laparoscopic procedures. When working in very small spaces it's difficult to tie a knot."

There are medical glues currently in use, but they have some problems, Karp said.
"Although they provide very strong levels of adhesion, they are very difficult to work with. They have poor mechanical properties, they are very brittle, and they also induce a very strong inflammatory response," he said.

The MIT researchers said the gecko-inspired bandages could be in clinical trials within two to five years.

Don't Prescribe Antibiotics for Adult Sinus Woes

(HealthDay News) -- It's extremely difficult for doctors to tell the difference between sinus infections that can be cured by antibiotics and those that can't, a new review finds.

Given the growing problem of antibiotic resistance, the study authors urge that physicians give up using antibiotics altogether for adult patients with rhinosinusitis -- even when symptoms persist beyond a week.

"Antibiotics offer little benefit for patients with acute rhinosinusitis-like complaints," wrote the research team led by Dr. Jim Young of University Hospital Basel, Switzerland. "Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days," they added in the March 15 issue of The Lancet.

The European group noted that upper respiratory tract infections are responsible for a full third of doctor's appointments in the United States, and a third of those visits end in a diagnosis of rhinosinusitis. Currently, about 80 percent of patients receive a prescription for an antibiotic.

Antibiotics are only useful against bacterial disease -- they do not fight viral infections. But how good are doctors at distinguishing between the two in the typical clinical setting?

To find out, Young's group looked at data from nine trials with a total of more than 2,500 adult patients with rhinosinusitis. Doctors in the trials used a patient's medical history or symptoms -- for example, facial pain, pus-filled nasal discharge, or a prior cold -- that have been thought helpful in distinguishing a bacterial infection from a viral one.

Unfortunately, even these symptoms failed to help doctors determine whether antibiotics were appropriate. In fact, the analysis found that 15 patients with rhinosinusitis-like complaints had to be given antibiotics before one additional patient benefited from treatment, meaning that the other 14 were getting the drugs for no real purpose, the authors wrote. The result didn't change, regardless of patient age or duration or severity of symptoms.

The findings only apply to adult patients because children were not included in the study, the researchers stressed.

However, one otolaryngologist said the study goes too far in banning antibiotics for adult cases.

"This study should not convey the message that antibiotics are not indicated for all patients with sinusitis," Dr. Jordan S. Josephson, of Lenox Hill Hospital in New York City, said in a statement. He believes that while the drugs are certainly ineffective against viral sinusitis, they can offer patients with acute bacterial infections "significant symptom relief and improvement."

Josephson notes the study does not address "the 30-plus million Americans that suffer from chronic sinusitis." He said the evidence is clear that many patients with these longer-term sinus problems do benefit from antibiotic therapy.

However, the new findings mirror those of a study published last March in the Archives of Otolaryngology Head and Neck Surgery. That study found that U.S. doctors are consistently overprescribing antibiotics for sinus infections.

But even the physician who led that research doesn't see how the problem can be eliminated.

That's because when it comes to treatments for sinus trouble, antibiotics are the best of a bad lot, said Dr. Donald A. Leopold, chairman of the department of otolaryngology at the University of Nebraska Medical Center.

"We as physicians don't have very good medications for chronic rhinosinusitis," he said. "The only other drugs in contention are topical steroids, and they are not great. As a group, I suggest we are frustrated at not having good drugs. It would be great if we had better medications for this chronic inflammation."

Another factor is what patients demand, Leopold said. "Many patients call up and ask for specific antibiotics," he said. "The patients know these names. They have been marketed to them, so they know the drugs are available. And antibiotics do give some relief."

According to the Archives of Otolaryngology Head and Neck Surgery report, two national studies showed that Americans made more than 17 million visits to health-care facilities for sinus infections between 1999 and 2002. At least one antibiotic was prescribed in nearly 83 percent of cases of acute rhinosinusitis and in nearly 70 percent of cases of the chronic, longer-running version of the condition, in which symptoms persist for at least 12 weeks.

Doctors understand that overprescribing antibiotics can lead to a dangerous microbial resistance to the drugs. But it's hard to preach that wisdom to someone with a drippy, hurting sinus who wants immediate relief, Leopold acknowledged. Because more effective drugs are lacking, "patients are desperate, physicians are desperate, and it is not a happy situation," he said.

Consider the case of the working physician called on to treat such a patient, said Dr. Neil L. Kao, vice chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology. He happens to be just such a working physician, in private practice in Greenville, S.C.

There are ways to determine whether a sinus infection is bacterial, Kao said. One is to do endoscopy, running a tube into the nose to obtain a sample of mucus from the sinus. Another is nasal cytology, examining a swab from the lining of the nose. A third is to take an X-ray.

"The problem with all of these is that they are expensive and time-consuming," Kao said. "The differences between symptoms caused by an allergy, bacterial infection, viral infection and a common cold are few. For us, even specialist doctors, when you see someone with acute nasal symptoms, it is hard to tell the cause. And the truth is that most of the people diagnosed with sinusitis go to primary-care doctors."

Public awareness about antibiotic resistance is increasing, but most people suffering from cough, drip, lack of sleep and other sinus symptoms are likely to come in demanding an antibiotic, Kao said.

And so the physician often makes the practical choice of giving what the patient wants, with a chance of relief, over the more abstract issue of antibiotic resistance, he said.

More information
For more on sinus infections, head to the U.S. Centers for Disease Control and Prevention.